Journal of Family & Reproductive Health

Immunotherapy: the Mega Weapon to Cure Cancer

Zakaria Rostamitehrani — 2026-07-12

Objective: Cancer is one of the most complex genomic diseases that can gain abilities to resist different therapies. These capabilities, known as the hallmark of cancer, allow specific and personalised therapies such as immunotherapy.

Materials and methods: This review paper discusses how different immunotherapies, such as immune checkpoint blockade, chimeric antigen receptor (CAR) T-cell, and Oncolytic viral therapy, which are currently being used and researched to overcome cancer cell capabilities by using the patient’s immune system.

Results: Immune checkpoint blockade therapy is used to block immune inhibitory pathways using anti-PD-1 receptor and anti-CTLA-4 receptor antibodies, which make lymphocytes more responsive towards cancer cells. Then, it is discussed how CAR T-cells are designed to make cancer antigens more easily identified by T-cells for a more specific immune response. Furthermore, it is shown that oncolytic viruses directly destroy cancer cells and, indirectly, make them more vulnerable to the immune system.

Conclusion: It is proposed that oncolytic viral therapy is a bridge between Immune checkpoint and CAR T-cell therapies for a more effective and more specific immune response towards cancer

Therapeutic Roles and Safety Profiles of Non-Vitamin Antioxidant Supplements in Female Infertility: A Narrative Review

Effat Davoudi-Monfared — 2026-07-12

Objective: Treatment of female infertility consists different strategies including metabolic, hormonal and surgical therapeutic modalities. Non-vitamin supplements with antioxidant activity as carnitines, Inositols, Poly Unsaturated Fatty Acids (PUFAs), coenzyme Q10 and melatonin are among those with most popularity, but their prescription may confer some warnings.

Materials and methods: This review narrates the antioxidant mechanism of these supplements, beside their effect on outcomes of infertility treatment while considering side effects, warnings and ranges of doses.

Results: Carnitines are used for energy production and fat metabolism, while they have anti-aging and antioxidant effects. Supplementation with carnitines improve obesity outcomes, especially in Poly Cystic Ovarian Disease (PCOS) patients. Rare cases have shown increasing risk of seizure with levocarnitine. Coenzyme Q10 (Ubiquinone) has shown benefit in patients with PCOS or poor ovarian responders. It significantly increased live birth rate and the side effects are minimal even in higher doses. Poly Unsaturated Fatty Acids (PUFAs) have shown impact on follicular development and embryo quality. The hazard is increasing lipid low density lipoprotein (LDL) in high doses. Use of inositols in female infertility treatment is due to its metabolic effect and insulin resistance in PCOS patients resulting in decreasing use of gonadotropins. They have produced acceptable results about count of follicles and oocyte quality. Hypoglycemic effects of inositols have been reported as side effect, especially in combination with other hypoglycemic agents. Melatonin can increase the clinical pregnancy rate, and improve the outcomes about oocyte and quality of embryo via receptor- and non-receptor- action. Dizziness, drowsiness, and headache are reported in higher doses of melatonin.

Conclusion: The attitude that all supplement can be prescribed without restriction endangers susceptible patients. Hence, increasing our knowledge about efficacy and safety profile can help individualize prescription of supplements for female infertility.

Exploring the Causes and Management Barriers of Maternal Obesity in Iran: A Qualitative Study

Elnaz Kalantari — 2026-07-12

Objective: Obesity is a global health threat, especially among women of reproductive age, and it adversely affects the health of both mothers and their children. This study aimed to identify and analyze the causes and management challenges of maternal obesity in Iran from the perspectives of key informants.

Materials and methods: This is a qualitative study. We conducted semi-structured, in-depth interviews with 20 experts, from September to December 2023. We analyzed data using Leichter’s (1979) framework through an inductive-deductive approach, facilitated with MAXQDA 2020 software.

Results: We identified challenges in managing maternal obesity and categorized them into 10 main categories and 21 sub-categories, grouped within five constructs according to Leichter’s framework: Situational factors (climate changes and international sanctions), Structural factors (high prevalence of overweight and obesity among women and unfavorable economic conditions), Socio-cultural factors (misconceptions and misuse of traditional Iranian medicine), Environmental or International factors (social norms and values, and the limited influence of international organizations), and Governance and Executive factors (weak governance by the Ministry of Health and Medical Education (MoHME) and poor inter-sectoral cooperation).

Conclusion: Addressing maternal obesity is essential to achieve Sustainable Development Goals (SDGs), particularly in low- and middle-income countries (LMICs). Current challenges such as food insecurity, economic decline, and insufficient maternal awareness threaten maternal health in relation to obesity. Tackling these issues requires a coordinated, multi-sectoral approach involving healthcare system strengthening, public awareness campaigns, and empowerment of women and families. Prioritizing maternal obesity within national health agendas is critical for an effective response. Further research on maternal obesity in Iran is recommended to uncover root causes and develop effective interventions, providing policymakers with the evidence needed for informed decision-making.

Coping Strategies for Social Challenges in Mothers of Children With Autism: A Content Analysis Study

Reza Abdollahi — 2026-07-12

Objective: Mothers of children with autism spectrum disorder (ASD) in Iran encounter profound social challenges, such as stigma, blame, isolation, and inadequate support, intensified by cultural norms and limited resources. This qualitative study aimed to explore coping strategies used by these mothers in Urmia, northwestern Iran.

Materials and methods: Employing conventional content analysis per Graneheim and Lundman’s framework, we purposively sampled 18 mothers of children aged 3–18 years with confirmed ASD, ensuring maximum variation. Semi-structured in-depth interviews were conducted from January 2024 to June 2025 until data saturation. Transcripts were coded and analyzed iteratively via MAXQDA software, with rigor maintained through credibility, dependability, confirmability, and transferability.

Results: The overarching theme was “Multifaceted Coping Strategies for Social Challenges,” encompassing four categories: [1] Individual Coping Factors (acceptance, positive reappraisal, self-care, emotional regulation, knowledge acquisition); [2] Interpersonal and Relational Coping Factors (selective social engagement, family/spousal support, educating others); [3] Spiritual and Cultural Coping Factors (religious beliefs, prayer, finding meaning, patience); and [4] Community and External Support Coping Factors (support groups, advocacy, awareness efforts, professional guidance).

Conclusion: Mothers integrated emotion-focused (especially spiritual) and problem-focused strategies, influenced by Iranian cultural, religious, and collectivist contexts, underscoring needs for culturally tailored interventions, stigma reduction, and enhanced support services to bolster resilience.

Antibacterial Activity of DBD Plasma-Activated Saline Against Clinically Relevant Bacteria: Potential Applications in Family and Reproductive Health

Shervin Goudarzi — 2026-07-12

Objective: Effective infection control in family and reproductive healthcare settings is essential for preventing transmission of clinically significant pathogens. Plasma-activated saline (PAS), generated by non-thermal atmospheric-pressure plasma, has emerged as a promising eco-friendly antimicrobial agent due to the generation of reactive oxygen and nitrogen species (RONS). This study evaluated the antibacterial activity of PAS produced by a dielectric barrier discharge (DBD) plasma system and investigated its potential applicability in reproductive and family healthcare environments.

Materials and methods: In this experimental study sterile physiological saline was exposed to a DBD plasma system under atmospheric pressure for different activation durations. Antibacterial activity was evaluated against Pseudomonas aeruginosa, Klebsiella pneumoniae, Salmonella spp., Escherichia coli, Staphylococcus aureus, and Shigella sonnei. Bacterial suspensions were treated with PAS at different exposure times, and viable bacterial counts were quantified using the plate count method.

Results: Increasing plasma activation time significantly altered the physicochemical properties of saline, particularly by decreasing pH and increasing reactive nitrogen species concentrations. PAS demonstrated strong time-dependent antibacterial activity against all tested Gram-positive and Gram-negative bacteria. More than 99.9% (>3-log) reduction in viable bacterial counts was achieved after 1 minute of treatment. No detectable bacterial growth was observed after 3 minutes of exposure for Gram-negative bacteria, whereas Staphylococcus aureus required 4 minutes for complete inhibition. Statistical analysis demonstrated significant reductions in bacterial survival with increasing treatment duration.

Conclusion: DBD plasma-activated saline exhibited rapid and substantial antibacterial effects against clinically relevant pathogens associated with infection control. Its potent antimicrobial activity, environmental compatibility, and absence of persistent chemical residues highlight its potential as an alternative disinfectant for medical device sterilization, surface decontamination, and hygiene-related applications.

Preoperative Fibrinogen as a Biomarker Associated With Lymphovascular Space Invasion in Endometrial Carcinoma: A Cross-Sectional Study

Samina Sultana — 2026-07-14

Objective: Elevated fibrinogen levels have been associated with tumor progression in multiple malignancies; however, their relationship with lymphovascular space invasion (LVSI) in endometrial carcinoma remains insufficiently characterized. This study investigated the association between preoperative fibrinogen levels and LVSI and evaluated its potential as a preoperative biomarker.

Materials and methods: This cross-sectional analytical study included 152 patients with histologically confirmed primary endometrial carcinoma treated between August 2018 and August 2023 at Bangabandhu Sheikh Mujib Medical University and selected private clinics in Dhaka, Bangladesh. Preoperative plasma fibrinogen levels were measured using the Claus method. LVSI status was determined through histopathological examination of surgical specimens. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed.

Results: LVSI was identified in 30.3% of patients. Mean preoperative fibrinogen levels were significantly higher in patients with LVSI compared to those without (414.66 ± 117.94 mg/dL vs. 277.27 ± 89.34 mg/dL; p < 0.001). In multivariable analysis, each 100 mg/dL increase in fibrinogen was associated with a 2.34-fold increase in the odds of LVSI (adjusted odds ratio 2.34; 95% confidence interval 1.52–3.60;
p < 0.001). ROC analysis demonstrated good discriminatory performance (AUC 0.811; 95% CI 0.729–0.882). An optimal cut-off value of approximately 380 mg/dL yielded 65% sensitivity and 89% specificity.

Conclusion: Elevated preoperative fibrinogen levels are independently associated with LVSI in endometrial carcinoma and demonstrate good discriminatory performance. Fibrinogen may serve as a clinically accessible biomarker associated with LVSI and warrants further validation in larger prospective studies.

Companion and Type of Delivery: Inequalities in Brazil Revealed by the National Health Survey – 2019

José Cosme dos Santos Camargo — 2026-07-14

Objective: Birth companion is a contributory factor for humanization of labor, influencing favorable maternal and perinatal outcomes. Objective: To describe maternal and perinatal aspects of pregnancies that ended either with or without the participation of a companion during the labor period.

Materials and methods: This cross-sectional descriptive study was conducted in Brazil using data collected from the National Health Survey (PNS-2019). Participants were Brazilian women aged 15 to 49 years who had experienced pregnancy at some point in their lives and whose most recent delivery occurred between July 2017 and July 2019. Prevalence and 95% confidence intervals (95% CI) were calculated to characterize maternal and perinatal aspects according to the participation of a companion.

Results: The target population was estimated at 5.3 million women who underwent either cesarean section (54.58%) or vaginal delivery (45.42%) between July 2017 and July 2019. The prevalence of companion support was high (84.98%), with similar rates observed for cesarean section (85.52%) and vaginal delivery (84.33%). Private health insurance coverage, the number of prenatal appointments, and the place of the last delivery were associated with differences in companion participation rates in both delivery methods. In cesarean deliveries, the presence of complications during delivery and the number of postpartum appointments also influenced companion participation rates. In vaginal deliveries, older maternal age, higher parity, and episiotomy were associated with companion participation rates.

Conclusion: The participation of a companion during labor is high and independent of the delivery method; however, socioeconomic inequalities and unequal access to quality health services persist. Initiatives to strengthen policies supporting the humanization of labor and childbirth, and to guarantee the right to a companion during delivery, particularly within Brazil's Unified Health System (SUS), are essential for expanding and making the support more equitable for women in labor.

Ovarian Reserve and Anti-Thyroid Peroxidase Antibodies in Euthyroid Infertile Women: A Cross-Sectional Study

Tiba Mirzarahimi — 2026-07-14

Objective: This study investigated the association between Anti-TPO levels and ovarian reserve markers, including anti-Müllerian hormone (AMH) and antral follicle count (AFC), in euthyroid infertile women.

Materials and methods: In this cross-sectional analytical study, 231 euthyroid infertile women were enrolled and classified as Anti-TPO positive (n = 92) or Anti-TPO negative (n = 139). Serum levels of AMH, FSH, LH, TSH, prolactin, and Anti-TPO were measured, and AFC was assessed by transvaginal ultrasonography. Because hormonal variables were not normally distributed, logarithmic transformation was applied prior to parametric analyses. Data were analyzed using independent t-tests, Pearson correlation, and multivariate regression (α = 0.05).

Results: No significant differences were observed between groups in log-transformed AMH, AFC, FSH,
or LH levels (p > 0.05). Age was negatively associated with log-AMH. Subgroup analyses demonstrated that in Anti-TPO–positive women, higher Anti-TPO levels were associated with lower log-AMH and higher
log-FSH. Multivariate regression identified age as the only independent predictor of log-AMH levels
(β = –0.337, p < 0.001).

Conclusion: Ovarian reserve decline appears primarily age-related; however, thyroid autoimmunity may have a potential modulatory role in ovarian function. Consideration of thyroid autoantibody status may be clinically relevant in infertility evaluation.

Staphylococcus Aureus Toxic Shock Syndrome With Urinary Tract Infection

Medha Gudavalli — 2026-07-14

Objective: To describe a rare case of non-menstrual staphylococcal toxic shock syndrome (TSS) with Staphylococcus aureus urinary tract infection as the suspected primary source and to highlight the successful use of linezolid as adjunctive therapy when clindamycin resistance is present.

Case report: A 42-year-old woman presented with fever, vomiting, diarrhea, and severe vulvar pain. One month prior, she experienced vaginal pruritus with excoriations and fissuring that never fully resolved. On examination, she had conjunctival injection, tongue inflammation with non-vesicular lesions, and a diffuse erythematous macular rash. Laboratory evaluation revealed elevated transaminases, thrombocytopenia, and bandemia. Urinalysis demonstrated 100,000 CFU of Staphylococcus aureus. Gynecologic examination revealed vulvar and vaginal erythema with ulcerated cervical lesions. Vaginal culture also grew heavy Staphylococcus aureus. Given the constellation of fever, rash, mucosal involvement, hepatic dysfunction, and positive Staphylococcus aureus cultures, a diagnosis of toxic shock syndrome was made. The isolate was resistant to clindamycin, necessitating treatment with vancomycin, piperacillin-tazobactam, and linezolid. The patient improved and completed 14 days of antibiotic therapy with complete resolution of symptoms.

Conclusion: Staphylococcus aureus urinary tract infection is an exceedingly rare source of toxic shock syndrome. Clinicians should maintain a high index of suspicion for TSS in patients with any staphylococcal infection presenting with fever and multisystem involvement. Linezolid is an effective alternative to clindamycin for toxin suppression, particularly in cases involving clindamycin-resistant organisms. Prior mucosal barrier disruption may be an important risk factor for TSS development.

Methodological Inconsistency in Exercise Classification. A Comment on 'A Comparative Study of Whole Body Vibration Training and Pelvic Floor Muscle Training on Women's Stress Urinary Incontinence', Three-Month Follow-Up'

Necmettin Yıldız — 2026-07-18

The Article Abstract is not available.